Tricuspid Atresia?

Tricuspid atresia is a type of congenital heart disease in which the valve between
the right atrium and right ventricle fails to develop.

Blood that returns from the body to the right atrium cannot directly enter the right
ventricle, and must pass through a hole in the atrial septum (atrial septal defect) into
the left atrium and then the left ventricle.

There are several anatomic variations that influence the symptoms and course of
treatment in any given patient. There may be a hole in the ventricular septum, called
a ventricular septal defect (VSD).

The aorta and pulmonary artery may be normally positioned and aligned with the
appropriate ventricle (as shown in illustration), or they may be reversed, a condition
called transposition of the great arteries.

If there is no ventricular septal defect or only a small one, and the great arteries are
normally positioned, blood flows from the left ventricle out the aorta to the body. In
this situation very little, if any, blood can get to the lungs resulting in very low oxygen
levels in the infant.

In a newborn baby, blood can reach the lungs to pick up oxygen as long as a
connection between the aorta and pulmonary artery called the ductus arteriosus
remains open.

The "ductus" is an important vessel while the baby is still in the womb because it
allows the blood from the baby's heart to return to the placenta, which does the job
of the lungs before birth. This vessel is exquisitely sensitive to oxygen; when the
baby is born, it typically narrows down (or closes completely) after 24 to 48 hours in
response to the oxygen levels in the air breathed by the child. An
intravenous medication called prostaglandin can keep this important vessel open
after birth.

If a ventricular septal defect is present and the great arteries are in their normally
related position, blood from the left ventricle can reach the lungs through the
ventricular septal defect. This channel is often very narrow, and the right ventricle
very underdeveloped, so a less than normal amount of blood goes to the lungs.

Finally, if there is transposition of the great arteries, blood reaches the lungs easily
because the pulmonary artery is directly connected to the left ventricle. But blood
can only reach the body through the ductus arteriosus or the ventricular septal
defect if there is one.
Tricuspid Atresia signs and symptoms
The signs and symptoms of tricuspid atresia depend on the presence and size of the
ventricular septal defect, and the relationship of the great arteries.

Most commonly, the great arteries are normally related and there is either no
ventricular septal defect, or only a small ventricular septal defect.

In this case, the newborn baby with tricuspid atresia will have a low oxygen level and
a dusky, blue color, also called cyanosis. This cyanosis may be noted at birth, or
may only become evident after several days when the ductus arteriosus closes. As
the ductus closes the cyanosis worsens.

If the cyanosis is severe enough, the baby will develop symptoms of poor
oxygenation such as fast breathing or poor feeding.

Occasionally, there is an increased amount of blood flow to the lungs. This baby
may have little to no cyanosis, but this situation will likely develop congestive heart
failure because of this imbalance. The increased workload on the left ventricle and
easier path of blood flow to the lungs causes them to become engorged with blood,
and causes fluid to leak from the bloodstream into the air spaces of the lungs. This
condition is called pulmonary edema and makes it harder for a baby with this
condition to breathe comfortably. The combination of increased heart and lung work
uses large amounts of calories and results in the constellation of symptoms referred
to as congestive heart failure (CHF).

The symptoms of congestive heart failure are fast breathing, fast heart rate,
sweating with feeds and poor weight gain. If there is transposition of the great
arteries, the presenting symptoms are related to low blood flow through the aorta
and out to the body. This results in low blood pressure, fast breathing, poor feeding,
cold, clammy hands and feet, and a pale, gray color. Infants presenting with these
symptoms are critically ill and require emergency medical attention.

Tricuspid Atresia Diagnosis

Babies with tricuspid atresia may or may not have a heart murmur. The amount of
oxygen in the blood can be easily and painlessly measured using a machine called a
"pulse oximeter."

Based on the symptoms reported by the parents and physical examination of the
child, the physician will be prompted to order further tests to evaluate the heart.

The diagnosis of tricuspid atresia, and the associated specific problems such as a
ventricular septal defect or transposition of the great arteries, can be very accurately
diagnosed by echocardiography. This involves using an ultrasound machine to make
pictures of the heart and to show the direction and, in some cases, the amount of
blood flow through various parts of the heart and blood vessels.

A chest X-ray and electrocardiogram (EKG) will often be performed as well.

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Tricuspid Atresia treatment

The diagnosis of tricuspid atresia with too little blood flow to the lungs or to the body
requires immediate medical treatment.

In a newborn baby (less than 1-2 weeks old), a medication called prostaglandin E1
can be given intravenously to reopen the connection (ductus arteriosus) between the
pulmonary artery and aorta and improve blood flow to the lungs or body.

Children with tricuspid atresia and too little pulmonary blood flow will require surgery
to establish a connection between the arteries to the body and the arteries to the
lungs. This type of operation is call a modified Blalock-Taussig (BT) shunt, and
involves the placement of a small Gore-tex tube between the artery to the arm
(subclavian artery) and the arteries to the lungs (pulmonary artery).

If the problem is too much pulmonary blood flow (tricuspid atresia with a large
ventricular septal defect), blood flow to the lungs will usually need to be limited to
protect the lungs from becoming damaged by too much blood flow. This can be
accomplished by placing a band around the pulmonary artery so that blood flow to
the lungs is limited in a controlled way.

This can be accomplished by placing a band around the pulmonary artery so that it
is more difficult for blood to go to the lungs.

Finally, if the problem is inadequate blood flow through the aorta (tricuspid atresia
with ventricular septal defect and transposition of the great arteries), blood from the
normal size left ventricle will need to be routed to the aorta, and the aorta will usually
need to be reconstructed. Pulmonary blood flow can then be established by
placement of a modified BT shunt. This is essentially the Norwood procedure used
for hypoplastic left heart syndrome.

Pulmonary blood flow can then be established by placement of a modified BT shunt.

This is essentially the Norwood procedure used for hypoplastic left heart syndrome.

Whatever operation is necessary in the newborn period, children can expect to

undergo further heart surgery by the age of 3-6 months. This is true whether the
child has too much or too little pulmonary or systemic blood flow in the newborn
period and therefore did not require any surgery at that time.

The operation at 3-6 months is called a Bi-directional Glenn. The superior vena cava
is detached from the heart and connected directly to the pulmonary artery and the
BT shunt is removed. This allows blood from the upper body to flow directly to the
lungs to pick up oxygen without having to be pumped by the heart. It also prevents
blood that already has oxygen from returning to the lungs, and thereby keeps the
heart from doing unnecessary work.

After this operation, however, there is still blood returning from the body through the
inferior vena cava going directly back to the body without first passing through the
lungs. Because of this, some level of cyanosis will persist.

Between the ages of 2 and 5 years, children with tricuspid atresia will be ready for
the third operation required to optimize their circulation.

This operation is called the Fontan procedure, and involves connection of the inferior
vena cava directly to the pulmonary artery, thereby forcing all blood returning from
the body to pass through the lungs and pick up oxygen before being pumped to the
body. This allows a more normal color in the skin and lips as well as a more normal
oxygen saturation in the blood.

ricuspid atresia
Definition

Tricuspid atresia is a type of congenital heart disease in which the tricuspid heart valve is
missing or abnormally developed. The defect blocks blood flow from the right atrium to the right
ventricle.

Alternative Names

Tri atresia

Causes

Tricuspid atresia is an uncommon form of congenital heart disease that affects about 5 in every
100,000 live births. Twenty percent of patients with this condition will also have have other heart
problems.

Normally, blood flows from the body into the right atrium, then through the tricuspid valve to the
right ventricle and on to the lungs. If the tricuspid valve does not open, the blood cannot flow
from the right atrium to the right ventricle. Blood ultimately cannot enter the lungs, where it
must go to pick up oxygen (become oxygenated).
Infants with tricuspid atresia generally are cyanotic (bluish discoloration of skin) and easily
become short of breath.

Symptoms

 Cyanosis (bluish discoloration of the skin)

 Easily fatigued
 Shortness of breath (dyspnea)
 Fast breathing
 Poor growth

Exams and Tests

This condition may be discovered during routine prenatal ultrasound imaging or when the baby
is examined shortly after birth. Cyanosis is present from birth. A heart murmur is often present at
birth and may increase in loudness over several months.

Tests may include the following:

 ECG
 Echocardiogram
 Chest x-ray
 Cardiac catheterization
 MRI of the heart

Treatment

Once the diagnosis is made, the baby will be admitted to the neonatal intensive care unit (NICU).
A breathing machine (ventilator) may be needed to help the baby breathe. A medicine called
prostaglandin E1 is used to maintain circulation of blood to the lungs.

The condition always requires surgery. If the heart is unable to pump enough blood out to the
lungs and rest of the body, the first surgery usually occurs within the first few days of life. In this
procedure, an artificial shunt is inserted to maintain blood flow to the lungs. In some cases, this
first surgery is not necessary.

Afterwards, the baby usually goes home. The child will need to take one or more daily medicines
and be closely followed by a pediatric cardiologist, who will determine when the second stage of
surgery should be done.

Stage II of the operation is called the Glenn shunt or Hemifontan procedure. This procedure
connects half of the veins carrying blue blood from the upper half of the body directly to the
pulmonary artery. The surgery is usually done when the child is between 4 - 6 months of age.

During stage I and II, the child may still appear somewhat blue (cyanotic).
Stage III, the final step, is called the Fontan procedure. The remainder of the veins carrying blue
blood from the body is connected directly to the pulmonary artery leading to the lungs, and the
left ventricle now only has to pump to the body and no longer the lungs. This surgery is usually
performed between the ages of 18 months and 3 years of age. After this final step, the baby is no
longer blue (cyanotic).

Some patients may need more surgeries in their 20s or 30s if they develop hard to control
arrhythmias or other complications of the Fontan procedure.

In a few hospitals, heart transplantation is considered to be a better alternative to the 3-step

surgery process, but there are few donated hearts available for small infants.

Outlook (Prognosis)

Improvement can be expected with most surgical procedures. Unexpected death may occur with
heart arrhythmias.

Possible Complications

 Irregular, fast heart rhythms (arrhythmias)

 Chronic diarrhea (from a disease called protein loosing enteropathy)
 Heart failure
 Fluid in the abdomen (ascites) and in the lungs (pleural effusion)
 Blockage of the artificial shunt
 Strokes and other neurological complications
 Sudden death

When to Contact a Medical Professional

If your infant has new changes in breathing patterns, eats less (decreased feeing), or has skin or
mucous membranes that are turning blue (cyanotic), contact your health care provider
immediately.

Prevention

There is no known way to prevent tricuspid atresia.

Definition

Tricuspid atresia is a heart defect present at birth (congenital) in which one of the valves
(tricuspid valve) between two of the heart's chambers isn't formed. Instead, there's solid tissue
between the chambers.

If your baby is born with tricuspid atresia, blood can't flow through the heart and into the lungs
to pick up oxygen as it normally would. The result is the lungs can't supply the rest of your
baby's body with the oxygen it needs. Babies with tricuspid atresia tire easily, are often short of
breath and have blue-tinged skin.

Tricuspid atresia is treated with surgery. Most babies with tricuspid atresia who have surgery
will live well into adulthood, though follow-up surgeries are often needed.

Symptoms

Tricuspid atresia symptoms include:

 Blue tinge to the skin and lips (cyanosis)

 Difficulty breathing (dyspnea)
 Tiring easily, especially during feedings
 Slow growth

Most babies who have tricuspid atresia show symptoms within the first week after birth.

Some babies with tricuspid atresia may also develop symptoms of heart failure, including:

 Fatigue and weakness

 Swelling (edema) in the legs, ankles and feet
 Swelling of the abdomen (ascites)
 Sudden weight gain from fluid retention
 Irregular or rapid heartbeat

When to see a doctor

Tell your doctor if you notice any of the above symptoms in your child.

Causes
By Mayo Clinic staff

CLICK TO ENLARGE
Chambers and valves of the heart

Tricuspid atresia
Tricuspid atresia occurs during fetal growth when your baby's heart is developing. While some
factors, such as heredity or Down syndrome, may increase your baby's risk of congenital heart
defects, such as tricuspid atresia, the cause of congenital heart disease is unknown in most cases.

The normal-functioning heart Your heart is divided into four chambers, two on the right and
two on the left. In performing its basic job — pumping blood throughout the body — your heart
uses its left and right sides for different tasks. The right side moves blood to the lungs. In your
lungs, oxygen enriches the blood, which then circulates to your heart's left side. The left side of
the heart pumps blood into a large vessel called the aorta, which circulates the oxygen-rich blood
to the rest of your body. Valves control the flow of blood into and out of the chambers of your
heart. These valves open to allow blood to move to the next chamber or to one of the arteries,
and they close to keep blood from flowing backward.

When things go wrong

In tricuspid atresia, the right side of the heart can't properly pump blood to the lungs because the
tricuspid valve, located between the upper right chamber (atrium) and the lower right chamber
(ventricle), is missing. Instead, a solid sheet of tissue blocks the flow of blood from the right
atrium to the right ventricle. As a result, the right ventricle is usually very small and
underdeveloped (hypoplastic).

Blood instead flows from the upper right chamber to the upper left chamber through a hole in the
wall between them (septum). This hole is either a heart defect (atrial septal defect) or an enlarged
natural opening (foramen ovale) that is supposed to close soon after birth. If a baby with
tricuspid atresia doesn't have an atrial septal defect, the baby may need a procedure to create this
opening.

Once the blood flows from the right atrium to the left atrium, the heart's left side must pump
blood both to the rest of the body and to the lungs. The blood reaches the lungs from the left side
of the heart through another natural opening between the right and left sides (ductus arteriosus)
that is supposed to close soon after birth. When necessary, this passageway is kept open using
medication in babies with tricuspid atresia. (When the foramen ovale and the ductus arteriosus
are open, they are referred to as being "patent.")

Some babies with tricuspid atresia have another heart defect — a hole between the lower two
chambers (ventricular septal defect). In these cases, blood can flow through the hole and into the
right ventricle, which pumps it to the lungs.

Risk factors
By Mayo Clinic staff

In most cases, the exact cause of a congenital heart defect, such as tricuspid atresia, is unknown,
but several factors may increase the risk of a baby being born with this condition:

 A mother who had German measles (rubella) or another viral illness during early pregnancy
 A parent who has a congenital heart defect
  Drinking too much alcohol during pregnancy
 A mother who has poorly controlled diabetes
 Use of some types of medications during pregnancy, such as the acne drug isotretinoin (Claravis,
Sotret) and some anti-seizure medications
 The presence of Down syndrome, a genetic condition that results from an extra 21st
chromosome

Complications
By Mayo Clinic staff

Prompt treatment helps avoid potentially fatal complications of tricuspid atresia, including:

 Lack of oxygen to tissues (hypoxemia). Tricuspid atresia may result in your baby's tissues
getting too little oxygen, a condition that can be life-threatening.
 Increased red blood cell count (polycythemia). If your baby has tricuspid atresia, his or her body
may begin to produce a greater than normal number of red blood cells to try to compensate for
the lack of oxygen caused by tricuspid atresia. This can interfere with normal blood flow, which
may lead to blood clots, a heart attack or a stroke.

Complications later in life

Although treatment greatly improves the outcome for babies with tricuspid atresia, they may still
have the following complications later in life, even after surgery:

 Formation of blood clots that may lead to a clot blocking an artery in the lungs (pulmonary
embolism) or to a stroke
 Easily tiring when participating in sports or other exercise
 Heart rhythm abnormalities (arrhythmias)

Preparing for your appointment

By Mayo Clinic staff

A congenital heart defect such as tricuspid atresia is often identified within the first week of life.
Whether problems are first noted in the hospital or later by you and your primary care doctor,
eventually your baby will be seen by a cardiologist who has experience in treating congenital
heart defects.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good
idea to be well prepared for your appointment with the cardiologist. Here's some information to
help you get ready, and what to expect from your cardiologist.

What you can do

 Write down any symptoms you've noticed in your child, including any that may seem unrelated
to a heart defect.
  Write down important personal information, including any family history of congenital heart
disease or any illnesses the mother may have had during pregnancy.
 Take a family member or friend along, if possible. Sometimes it can be difficult to remember all
the information provided to you during an appointment. In addition, learning that your baby has
a serious heart condition and will need surgery is likely to be distressing, making it harder to
remember all of the details your doctor may go over with you.
 Write down questions to ask your doctor.

Preparing a list of questions can help you ensure that you cover all of the points you want to. For
a congenital heart defect, some basic questions to ask your child's cardiologist include:

 What could be causing my child's symptoms?

 Are there other possible causes for these symptoms?
 What kinds of tests will my child need? Do these tests require any special preparation?
 What are the long-term effects of a congenital heart defect?
 What is the best course of action for my child?
 What are the alternatives to the primary approach that you're suggesting?
 Will my child need more than one surgery?
 How can I make my child more comfortable?
 Are there any restrictions or special instructions that I need to follow for my child?
 Will my child need to take medications? If so, are there generic alternatives to the medicines
you're prescribing?
 What about future pregnancies? Is there any way I can prevent this from happening again?
 Are there any brochures or other printed material that I can take home with me? What websites
do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask
additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve
time to go over any points you want to spend more time on. Your doctor may ask:

 When did you first notice symptoms in your child?

 Have your child's symptoms been continuous or occasional?
 What, if anything, seems to improve your child's symptoms?
 Does anything make your child's symptoms worse?

Tests and diagnosis

Before birth
Because of advances in ultrasound technology, it's possible for a baby to be diagnosed with
tricuspid atresia before he or she is born. Doctors can identify the condition on a routine
ultrasound exam during pregnancy.
After birth
After your baby is born, his or her doctor may suspect a heart defect, such as tricuspid atresia, if
your baby has a blue cast to his or her skin or is having trouble breathing. Your baby's doctor
may also suspect a heart defect if he or she hears a heart murmur — an abnormal whooshing
sound caused by turbulent blood flow.

Doctors typically use an echocardiogram to diagnose tricuspid atresia. This test uses high-
pitched sound waves that bounce off your baby's heart to produce moving images your baby's
doctor can view on a video screen.

In a baby with tricuspid atresia, the echocardiogram reveals the absence of a tricuspid valve and
a smaller than normal right ventricle. Because this test tracks blood flow, it can also measure the
amount of blood moving through holes in the walls between the right and left sides of the heart.
In addition, an echocardiogram can identify associated heart defects, such as an atrial septal
defect or a ventricular septal defect.

Treatments and drugs

There's currently no way to replace the defective tricuspid valve. Treatment for tricuspid atresia
involves surgery to ensure adequate blood flow through the heart and into the lungs, allowing
your baby's body to receive the proper amount of oxygen-rich blood. Often, this requires more
than one surgical procedure.

Surgery
A surgery called the Fontan procedure is the standard treatment of tricuspid atresia. During a
Fontan surgery, the surgeon creates a path for the oxygen-poor blood returning to the heart to
flow directly into the pulmonary arteries, which then transport the blood into the lungs.

However, most children with tricuspid atresia don't undergo the Fontan procedure until they are
at least 2 years old.

Some children with tricuspid atresia aren't good candidates for the Fontan procedure. If that is
the case, your child's doctors will discuss other options, including the possibility of a heart
transplant.

Before surgery
Before the Fontan surgery, other measures — including medications, procedures and other
surgeries — are often necessary to stabilize your child's medical condition and ensure proper
growth. These may include:

 Taking prostaglandin drugs. Before surgery, your child's cardiologist may recommend that your
child take the medication prostaglandin to help widen (dilate) the blood vessels and keep the
ductus arteriosus and the foramen ovale open.
 Preventive antibiotics. The cardiologist also will likely recommend that your child take
preventive antibiotics before certain dental and other procedures to prevent bacteria from
 entering the bloodstream and infecting the inner lining of the heart (infective endocarditis).
Practicing good oral hygiene — brushing and flossing teeth, getting regular dental checkups — is
another good way of preventing infection.
 Preliminary procedures. The so-called rescue surgeries your baby may need before the Fontan
procedure depend on how much blood is reaching his or her lungs. Following are some of the
procedures babies with tricuspid atresia may require:
o Atrial septostomy. This procedure creates or enlarges the opening between the heart's
upper chambers (atria) to allow more blood to flow from the right atrium to the left
atrium.
o Shunting. Creating a bypass (shunt) from the main blood vessel leading out of the heart
(aorta) to the pulmonary arteries allows for adequate blood flow to the lungs. Surgeons
typically implant a shunt during the first four to eight weeks of life. However, babies
usually outgrow this shunt and may need another surgery to replace it.
o Glenn procedure. When babies outgrow the first shunt, they often require a surgery
that sets the stage for the Fontan procedure. Doctors usually perform the Glenn
procedure when a child is about 6 months old. It connects one of the large veins that
return blood to the heart (superior vena cava) to the pulmonary artery. This allows
oxygen-poor blood to flow directly to the lungs. The procedure reduces the workload on
the left ventricle, decreasing the risk of damage to it.

Follow-up care
To monitor his or her heart health, your baby will need lifelong follow-up care with a
cardiologist who specializes in congenital heart disease. Your child's cardiologist will tell you
whether your child needs to continue taking preventive antibiotics before dental and other
procedures. In some cases, your child's cardiologist may recommend limiting vigorous physical
activity.

The short- and intermediate-term outlook for children who have a Fontan procedure is generally
promising. Outcomes for those having surgery later in life are generally worse. A variety of
complications may occur over time and sometimes require additional procedures. If the
circulation system created by the Fontan procedure fails, then a heart transplant may be
necessary. Talk to your child's doctor about his or her specific situation.

Lifestyle and home remedies

By Mayo Clinic staff

If your baby's born with tricuspid atresia, it may seem that almost all your time is spent at the
hospital or at a doctor's office. But there will be time spent at home, as well. Here are some tips
for caring for your child at home.

 Strive for good nutrition. Your baby may have a difficult time taking in enough calories, both
because he or she tires more easily during feeding and because of an increased demand for
calories. It's often helpful to give your baby frequent, small feedings. Breast milk is an excellent
source of nutrition, but formula works well, too. You may find that a combination of both
provides a good balance of nutrition and flexibility. Ask your doctor or hospital about available
 resources for pumping breast milk. Some hospitals rent breast pumps. Your child's cardiologist
may also recommend nutritional supplements or visiting a dietitian.
 Practice good oral hygiene. As your child gets older, help him or her practice flossing and
brushing. Although your child's cardiologist may recommend preventive antibiotics before
dental procedures, you can help prevent infections and the need for dental procedures by
keeping your child's teeth free from cavities.
 Help your child stay active. Encourage as much normal play and activity as your child is able to
tolerate, or as your doctor recommends, with ample opportunity for rest and nap time. Staying
active helps your child's heart stay fit. As your child grows, talk with the cardiologist about which
activities are best for your child. If some are off-limits, such as competitive sports, encourage
your child in other pursuits rather than focusing on what he or she can't do.
 Keep up with routine well-child care. Standard immunizations are encouraged for children with
congenital heart defects, as well as vaccines against the flu, pneumonia and respiratory syncytial
virus (RSV) infections.

Coping and support

By Mayo Clinic staff

Caring for a baby with a serious heart problem, such as tricuspid atresia, can be challenging and
stressful. Here are some strategies that may help make it easier:

 Try to maintain normalcy and closeness. Although you may feel uncertain at times about how
to best promote your child's health, maintaining stability and a regular daily routine will help
both you and your child relax and feel more secure in spite of circumstances. Even if your baby is
in the hospital, try to spend as much time together as you can. If you have other children,
include them as much as possible. Bonding together as a family is important for your baby's
social and emotional development.
 Seek support. Ask for help from family members and friends. Talk with your child's cardiologist
about support groups and other types of assistance that are available near you. The American
Heart Association offers a support group called Mended Little Hearts. Call 888-HEART99 (888-
432-7899) or visit its website to find out if there's a group in your area.
 Record your baby's health history. You may want to write down your baby's diagnosis,
medications, surgery and other procedures and the dates they were performed, the name and
phone number of your child's cardiologist, and any other important information about your
baby's care. It's also helpful to include copies of the operative reports from your child's surgeons
in your records. This information will help you recall the care your child has received, and it will
be useful for doctors who are unfamiliar with your baby to review his or her health history.
 Talk about your concerns. As your child grows and develops, you may worry about different
aspects of your child's care. Be sure to discuss your concerns with your child's cardiologist.

Although every circumstance is different, remember that many children with congenital heart
defects, such as tricuspid atresia, grow up to lead enjoyable lives.

Prevention
By Mayo Clinic staff
In most cases, congenital heart defects, such as tricuspid atresia, can't be prevented. If you have a
family history of heart defects or if you already have a child with a congenital heart defect, a
genetic counselor and a cardiologist experienced in congenital heart defects can help you look at
possible risks associated with future pregnancies.

Some steps you can take that might reduce your baby's risk of heart and other birth defects in
pregnancy include:

 Get adequate folic acid. Take 400 micrograms of folic acid daily. This amount, which is often
already in prenatal vitamins, has been shown to reduce brain and spinal cord defects, and folic
acid may help prevent heart defects, too.
 Talk with your doctor about medication use. Whether you're taking prescription or over-the-
counter drugs, an herbal product or a dietary supplement, check with your doctor before using
them during pregnancy.
 Avoid chemical exposure, whenever possible. While you're pregnant, it's best to stay away
from chemicals, including cleaning products and paint, as much as you can.